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<meta name="description" content="7月31日的网课，我看的回放。 不是完整记录，只是记录一些我觉得对我有用的地方。1.下颌前磨牙5个根管的。根管较多，先充填难充的，完了如果有牙胶阻挡，可以再预备。病历书写不要写“牙龈无异常”，写“牙龈未见异常”。操作时“一看二慢三通过”。2.重度弯曲根管每次使用超声时间不应超过20s。预弯6#先锋锉尖端2mm进入根管并建立通路至根尖，测长度，依次使用8#，10#锉通畅根管。根管冲洗后均用10#锉回">
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        <p>7月31日的网课，我看的<a target="_blank" rel="noopener" href="https://apptoxhg2d24446.h5.xiaoeknow.com/content_page/eyJ0eXBlIjoxMiwicmVzb3VyY2VfdHlwZSI6NCwicmVzb3VyY2VfaWQiOiJsXzVlZTliYmY0YzIxMTdfdmxsTThBQWgiLCJwcm9kdWN0X2lkIjoiIiwiYXBwX2lkIjoiYXBwdG94SEcyRDI0NDQ2IiwiZXh0cmFfZGF0YSI6MH0?app_id=apptoxHG2D24446&entry=2&entry_type=2002&from=timeline">回放</a>。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/01.png"></p>
<p>不是完整记录，只是记录一些我觉得对我有用的地方。<br>1.下颌前磨牙5个根管的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/02.png"><br>根管较多，先充填难充的，完了如果有牙胶阻挡，可以再预备。<br>病历书写不要写“牙龈无异常”，写“牙龈未见异常”。<br>操作时“一看二慢三通过”。<br>2.重度弯曲根管<br>每次使用超声时间不应超过20s。<br>预弯6#先锋锉尖端2mm进入根管并建立通路至根尖，测长度，依次使用8#，10#锉通畅根管。根管冲洗后均用10#锉回锉。<br>弯曲根管使用0420牙胶做主尖。<br>大于20°-30°的根管称为重度弯曲根管。<br>如果没有CBCT，如何诊断弯曲根管？偏移透照。<br>要诊断“慢性根尖周炎急性发作”要先有“慢性根尖周炎”。<br>10#锉回锉与顺滑通路的关系？每次更换锉的时候都要回锉。<br>病历书写：转诊不用放到主诉里，检查按视探叩松龈的顺序写。<br>携热器热量只能到达断面下4-6mm，重度弯曲根管是否可以考虑在弯曲处用改良单根法充填，弯曲处上方用热牙胶。<br>术后使用抗生素是否必要？观察期是否有必要用临时冠修复？<br>重度弯曲根管还是可以达到满意的效果。两个关键难点：保持根管通畅，保持原始形态；清除感染。操作要点：用小号器械预弯。建立顺滑通路，至少建立到10#锉。解除冠方阻力。在根管成形中利用弹性好的器械。对于弯曲细窄的根管不建议用锥度大的器械作为完成锉。根充建议用单尖法。<br>3.牙源性面部皮瘘<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/03.png"><br>下7C型根管的概率在46.37%。<br>如无特殊情况，一般先拍根尖片，需要时再拍CBCT。如诊断不明，形态变异较大等情况。<br>根管消毒为啥用Vitapex而不用其它氢氧化钙。Vitapex封药的问题是取出困难，如去除不彻底，根充会有间隙。（回答：进货较困难。取的时候用超声。）<br>C形根管根充，如果不是完全分离的两个根管，而是中间有沟通，应该放副尖在沟通区域加压。<br>4.慢性根尖炎冠根一体化治疗<br>上6的MB2。<br>根充完成，流体树脂封闭根管口。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/04.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/05.png"><br>传统冠与嵌体冠修复比较。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/06.png"><br>牙体预备的考量<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/07.png"><br>已经在进行的根管治疗，未根充转诊，是否算根管再治疗？不算。<br>患牙牙龈红肿，如何处理？颈部颜色异常，边缘可以往下放。也可以做短全冠，边缘放到龈上。综合考虑。<br>固位可，一壁缺损，牙尖完整，可能无必要做髓腔固位冠。可以考虑金合金全冠。<br>5.下颌第一磨牙再治疗<br>近中三根管，有遗漏根管。金属桩核冠修复。<br>使用超声尖去除桩周围树脂及粘接剂，避免损伤牙体，震松金属桩。<br>下颌磨牙近中三根管发生率1%-15%，国人5%-10%。分为3-1,3-2,3-3型。<br>自冠方至根方逐步清理根管，每一步都充分化学冲洗，避免将感染物质推到根尖区域，降低术后反应的发生，促进了根尖大面积炎症的好转。<br>病历主诉描述用患者语言。<br>窦道消除后可否直接修复？可以的。<br>建议采用能阻射的氢氧化钙。<br>打桩为何打近中根？还好没侧穿。<br>对于窦道要看其位置，判断来源。<br>氢氧化钙，封药一到两周。封三四个月一般是为了根尖诱导成形了。<br>初诊一般拍根尖片。<br>6.磨牙根尖周骨病损影像<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/08.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/09.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/10.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/11.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0221-rctcase/12.png"><br>先再治疗17。<br>慢性根尖周炎的诊断：关键依据是根尖周X线骨密度影像变化感染来源。<br>根尖周炎要和非牙源性颌骨疾病等相鉴别。<br>下钻之前要明确“患牙”的牙髓活力。<br>工作宽度的确定：X3，用手锉确定根尖孔宽度是35#。<br>术后复查的愈合有可能是纤维性愈合。<br>基层医生如果搞不定，会诊/转诊。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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